糖尿病合并细菌性肝脓肿的临床特点与微创治疗  

Clinical characteristics and minimally invasive treatment of diabetes mellitus accompanied by pyogenic hepatic abscess

作　　者：秦建民[1] 顾新刚[2] 张敏[1] 孔雷[1] 殷佩浩[1] 曹伟家[1] 

机构地区：[1]上海中医药大学附属普陀医院普外科,上海200062 [2]上海中医药大学附属普陀医院超声科,上海200062

出　　处：《外科理论与实践》2009年第6期660-663,共4页Journal of Surgery Concepts & Practice

摘　　要：目的:探讨糖尿病合并细菌性肝脓肿的临床特点与微创治疗。方法:总结我院2004年2月至2009年9月收治的46例糖尿病合并细菌性肝脓肿病人的临床资料。32例在静脉应用胰岛素、抗菌素控制血糖与感染的基础上,由B超引导下行肝脏脓肿穿刺引流,其中4例同时行ERCP胆管取石结合鼻胆管引流;6例行腹腔镜探查、肝脓肿切开引流,其中4例同时行腹腔镜胆囊切除术;另8例采用保守治疗。结果:经保守治疗治愈8例,B超穿刺脓肿引流或腹腔镜脓肿切开引流治愈24例,脓腔缩小好转出院8例;临床治愈率达95.7%。另有2例病人脓肿穿刺引流后因中毒性休克并发心、肺、肾多脏器功能衰竭死亡,病死率为4.3%;4例病人行脓肿引流后出血,经保守治疗后而痊愈。结论:在积极控制血糖,有效控制感染的基础上,采用B超或腹腔镜微创技术引流脓肿,是糖尿病合并细菌性肝脓肿病人的首选治疗方法。Objective To discuss about the clinical characteristics and minimally invasive treatment of diabetes mellitus accompanied by pyogenie hepatic abscess. Methods Fourty-six cases of diabetes mellitus accompanied by pyogenic hepatic abscess were analyzed. On the basis of controlling the blood glucose and infection with insulin and antibiotics, 32 cases were treated by percutaneous transhepatic drainage under the guide of B type ultrasonography; calculi were removed and nasobiliary drainage was placed by ERCP technique among 4 cases. Six cases were performed a laparoscopy and incision ＆ drainage of the hepatic abscess, laparoscopic cholecystectomy was performed in 4 cases at the same time.Results Eight cases were cured by conservative therapy, ：24 cases were cured by incision ＆ drainage of the hepatic abscess with the help of B type ultrasonography or laparoscopy, among which 8 cases were discharged from the hospital following diminution of the abscess cavity. The clinical recovery rate was 95.7%. Two cases died of infectious shock and multiple organ failure, with a mortality of 4.3%. Bleeding after drainage of the abscess occurred in 4 cases, which was successfully controlled with conservative therapy. Conclusions On the basis of well controlling the blood glucose and infection, minimally invasive technique under the guide of B type ultrasonography or laparoscopy is the preferred modality to treat diabetes mellitus accompanied by pyogenic hepatic abscess.

关 键 词：糖尿病 细菌性肝脓肿 临床特点 微创技术 治疗 

分 类 号：R657.33[医药卫生—外科学] R587.1[医药卫生—临床医学]